E-cigarettes are becoming more and more popular around the world, and domestic e-cigarette companies often take the United Kingdom as an example. The British Department of Public Health supports smokers in the country to use e-cigarettes to quit smoking (quit cigarettes). Yes, the UK is indeed unique in its e-cigarette regulatory policy. In the UK, e-cigarettes are being promoted as a tool to quit cigarettes. Recently, the United Kingdom has also considered including e-cigarettes in smoking cessation prescriptions, which can be prescribed by doctors.
The domestic e-cigarette industry has thus found a basis for establishing itself. They used the British example to educate the domestic public and advocated that China should also learn the "British model".
But the problem is not simple. The e-cigarette industry intentionally or unintentionally ignored many details when promoting the "British Model", and ignored a key fact that China's regulation of tobacco and e-cigarettes is currently not too strict, but far from enough.
In an electronic cigarette experience store in Guanshanhu District, Guiyang City, a consumer is choosing electronic cigarettes (photographed on May 29). The "China Smoking Harmful Health Report 2020" released by the National Health and Health Commission on May 26 believes that the use of electronic cigarettes may be more likely to cause people to smoke cigarettes, and this phenomenon is especially obvious among teenagers. Xinhua News Agency
Is it "quit smoking" or "switch to e-cigarettes"?
Electronic cigarettes (e-cigarettes) are electronic atomization devices that generate mist by heating e-liquid, and the components of e-liquid are generally nicotine and flavor. Electronic cigarettes allow nicotine to be inhaled into the human body in the form of vapor, replacing the previous form of cigarette burning smoke.
Because e-cigarettes don't burn tobacco, some believe that e-cigarettes are less harmful than cigarettes. Some harmful substances formed by the burning of traditional cigarettes can cause smokers to suffer from lung cancer and other related diseases.
A core controversy about e-cigarettes is: can e-cigarettes really help quit smoking?
When e-cigarette companies promote the so-called "e-cigarettes can help smoking cessation and have significant effects" to the industry and the public, they may be selectively stating information and not telling you the full picture.
First of all, it is particularly important to note and emphasize that the so-called "e-cigarettes to help quit smoking" in the UK only refer to "quit cigarettes". There are two situations here: one is to completely quit any tobacco products containing nicotine, and neither cigarettes nor e-cigarettes are smoked; the other is to only quit cigarettes and replace them with e-cigarettes. This condition is also considered to be a successful "smoking cessation" in the setting of some studies.
Taking a study published in the internationally renowned medical journal "New England Journal of Medicine" in 2019 as an example, there are two criteria for a person to be considered "smoking cessation": one is that the total number of self-reported cigarettes smoked over a period of time does not exceed 5; the second is that the concentration of exhaled carbon monoxide is always less than 8ppm in all previous measurements made for a period of time.
The second criterion is actually a biochemical test to verify that the cigarettes are not actually smoked anymore.
Carbon monoxide is one of the main harmful substances released by the burning of cigarettes. Carbon monoxide is more likely to be formed in the center of the cigarette combustion zone, where the supply of oxygen is insufficient. Carbon monoxide is associated with cardiovascular disorders and hypoxic poisoning, and may cause organic lesions in severe cases. A cigarette can produce 0.3 to 0.4 mg of carbon monoxide.
The academic standard for "smoking cessation" is usually to quit cigarettes, not nicotine.
Some studies that concluded that e-cigarettes can aid smoking cessation generally only considered cigarette smoking. In reality, many people just switched from smoking cigarettes to vaping and continued to remain addicted to a harmful substance. This is not "quit smoking" in the full sense that ordinary people understand.
For example, in the aforementioned 2019 New England Journal of Medicine controlled study of e-cigarette smoking cessation: 886 people participated in the study and were divided into the e-cigarette smoking cessation group and the nicotine replacement therapy smoking cessation group, about a year later The "cessation rate" of quitting cigarettes was 18% (79 people) in the e-cigarette group and 9.9% (44 people) in the nicotine replacement therapy group. However, for those in the vaping group, 80 percent were still vaping a year later, compared with 9 percent who were still on nicotine replacement therapy.
If we do a conversion, the people who really completely abstain from any nicotine-containing products are 15 people (e-cigarette group) and 40 people (nicotine replacement therapy group), accounting for 3.4% and 8.9%, respectively.
So-called nicotine replacement therapy (NRT) is a drug that delivers nicotine to the brain as a skin patch, gum, nasal and oral spray, inhaler, lozenges, and tablets. The purpose of NRT is to replace the nicotine that smokers usually get from cigarettes, reducing the desire to smoke until they stop smoking altogether.
This means that only 3.6 percent of people in the study quit nicotine completely, while those who used nicotine replacement therapy had an 8.9 percent success rate after one year.
Of course, the sample size of this study itself is less than 900 people, "the representativeness of the study is not high."
In March 2021, the "E-Cigarette in England: 2021 Evidence Update" (Vaping in England: 2021 evidence update summary, hereinafter referred to as "2021 Evidence Update") published by the Public Health Agency of England also pointed out that long-term use of e-cigarettes The proportion of the population is increasing. Among British smokers who are using e-cigarettes, the proportion of people who have used e-cigarettes for more than 3 years increased from 23.7% in 2018 to 29.3% in 2019. In 2020, it further increased to 39.2%.
